State News: Ombudsman conflict over LTC executives

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Kansas Gov. Sam Brownback
Kansas Gov. Sam Brownback
KANSAS — Consumer advocates in Kansas are concerned about a series of decisions by Gov. Sam Brownback (R) to appoint nursing home industry veterans to high-level Department of Aging positions.

Appointees include Shawn Sullivan as aging secretary and Joe Ewert as commissioner for licensure, certification and evaluation. Sullivan was an administrator at a Wichita nursing home, while Ewert worked for the state's LeadingAge chapter. Critics became more vocal when Brownback appointed Barbara Hickert as long-term care ombudsman. Hickert also has been a facility administrator.

Mark Miller, New York's ombudsman, told the Kansas City Star that it's rare for a nursing home administrator to be appointed to a state ombudsman post. “I think that's something the average person would have a question about,” Miller said.

Low-income caregivers
CALIFORNIA — Caregivers for low-income seniors and the disabled often live in poverty or near-poverty themselves, according to a new study.

In “Hidden in Plain Sight: California's Paid Medi-Cal Caregivers Are Vulnerable,” UCLA researchers say that about 290,000 paid caregivers in California provide services to adults on Medi-Cal, the state Medicaid program for adults with long-term illnesses or disabilities. These caregivers earn an average of less than $11 per hour and have monthly incomes of about $1,970, which is below 200% of the federal poverty level.

Medi-Cal caregivers also had food insecurity rates that were twice as high as low-income unpaid caregivers. Food insecurity refers to cutting back on meal sizes or skipping meals.

“Paid caregivers do a lot but get paid very little,” lead author and Ph.D. candidate Geoffrey Hoffman said. “They play a critical and complex role caring for our aging or disabled parents, grandparents, friends and neighbors yet can earn only a little more than minimum wage.”

Hoffman said further cuts to state programs for seniors would come at the expense of California's seniors and paid caregivers.

Risperdal ruling
ARKANSAS — The battle over the prescribing and marketing of antipsychotics to seniors suffering from dementia shows no signs of abating. The latest blow is a $1.2 billion court decision against a pharmaceutical giant accused of too aggressively pushing the drug Risperdal, which is taken by many seniors with Alzheimer's disease.

The Arkansas Medicaid program spent a total of $8.1 million on prescriptions for Risperdal. A lawsuit against Johnson & Johnson claims that side effects, including diabetes and schizophrenia, were either not noted or downplayed by Ortho-McNeil-Janssen Pharmaceuticals, a J&J sub-unit.

A jury ultimately ruled against Janssen. Pulaski County Circuit Judge Tim Fox handed down the $1.2 billion judgment. That encompasses fines of $5,000 each for 238,874 fraudulent prescriptions that the state said Medicaid paid for.

It is one in a series of decisions against J& J in various states. The federal government rejected a settlement offer with the company for $1 billion in March.

Ombudsman case approved
FLORIDA — The Florida ombudsman case against the state and long-term care provider groups can proceed, a judge decided in mid-April.

Circuit Judge James Shelfer denied motions to dismiss the lawsuit filed by Brian Lee, who is suing the state Department of Elder Affairs, the Florida Health Care Association and the Florida Assisted Living Association. Lee is seeking damages of more than $15,000, the Miami Herald reported.

As ombudsman, Lee had asked long-term care providers to submit ownership information. He says he was forced to resign because of it in February 2011. Among the assertions is that FALA and FHCA asked Gov. Rick Scott if the ombudsman could be someone with “closer ties to the industry.”

In addition to alleging tortuous interference by FALA and FHCA, Lee says that he was covered under the Florida Whistle-Blower Retaliation laws.

The defendants, however, say that the right to free speech protects their clients and that no malfeasance occurred.
Lee has since started a long-term care resident advocacy group that is called Families for Better Care.

Infection rates down

PENNSYLVANIA — Infection rates have improved in Pennsylvania nursing homes, the result of a program targeted at healthcare-acquired infections, a new report reveals.

In 2010, long-term care facilities in Pennsylvania reported declining infection rates in all five areas of care, including dementia units, mixed units, nursing units, skilled nursing/short-term rehabilitation units and ventilator-dependent units, according to the 2011 Patient Safety Authority annual report.

Additionally, nursing homes — which have been required to report HAIs to the Authority since 2010 — reported a reduction in urinary tract infections by 14% in residents without a catheter and by 15% in residents with catheters.

There also were 18% fewer skin and soft-tissue infection reports compared to 2009 data, according to the report.

Under the Pennsylvania program, the Patient Safety Authority assigns each liaison between 65 and 100 healthcare facilities, which they can visit regularly and provide infection prevention resources.

SNFs hit with cuts
ILLINOIS — Facing a human services budget gap of roughly $2.7 billion, Illinois Gov. Pat Quinn (D) announced spending cuts worth $1.38 billion in the human services budget.

The proposed cuts will hit skilled nursing facilities hard, Aging in Chicago reported. Proposed cuts include: a reduction in nursing facility capital rates; the elimination of paid “bed holds” for adults of ages 21 and over in SNFs and supportive living facilities; a moratorium on admissions to intermediate care nursing facilities and others.

Illinois is eight months behind in reimbursing more than $600 million in nursing home Medicaid claims.

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